Dissociation : Vol. 8, No. 2, p. 073-083 : Treatment of DID and DDNOS patients in a regional institute for ambulatory mental health care in the Netherlands: a survey

Dissociation : Vol. 8, No. 2, p. 073-083 : Treatment of DID and DDNOS patients in a regional institute for ambulatory mental health care in the Netherlands: a survey

Author:

Groenendijk, Ingrid; Hart, Onno van der, 1941-

Abstract:

To survey the number and characteristics of DID and DDNOS patients treated at a Regional Institute for Ambulatory Mental Health Care in the Netherlands, their treatment goals and treatment course, and the organizational investment, semi-structured interviews were held with therapists about all patients diagnosed with DID or DDNOS during a three-month period (May 31, 1993 - August 31, 1993), and a study of these patients' files took place. One hundred one patients received a dissociative disorder diagnosis, i.e., forty-one the diagnosis of DID and sixty the diagnosis of DDNOS. On average, these patients received the dissociative disorder diagnosis after a treatment period of over two years. Most therapists followed a basic stage-oriented treatment model. In the majority of cases, hypnosis was an important adjunctive technique. For more than half of the patients (DID:53.7%; DDNOS:60.0%), therapists reported stabilization and symptom reduction as the treatment goal. For one-third (DID: 39.0%; DDNOS: 31.6%), the focus included treatment of traumatic memories as well as reintegration and rehabilitation. This objective was chosen within one to three years of stabilization and symptom reduction. Average treatment length was six years, most often with a frequency of one session a week. In 10% of all cases, a second therapist joined the treatment. Therapists reported concern with regard to: boundary issues, co-therapy, diagnostic issues, (contra) indications for treatment of traumatic memories, attachment problems, cooperation with other agencies, underdevelopment with regard to dissociative disorders in child and adolescent mental health care. The emphasis on supportive therapy only and the use of secondary therapists may perhaps be different from clinical approaches elsewhere.